Routine inspection·December 13, 2023

On 12/13/2023 at 3:30pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced 1-Year Required inspection. LPA met with Emily Aliping, Administrator and LPA explained the purpose of the visit. The Administrator currently holds a certificate (#6007022740) that expires on 8/25/2024. The facility’s fire clearance was approved for four (5) non-ambulatory and two (2) ambulatory residents. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of four (4) total bedrooms and three (3) bathrooms. One (1) bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 111.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors/ carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 6/13/2022. Emergency Disaster Plan was last posted on 10/24/2022. First aid kit was observed to be complete. Fire drill was last conducted on 5/13/2023. Continued on LIC809. Continued from LIC809. Four (4) staff records were reviewed and all staff records were compete. All four (5) resident records were reviewed and complete. LPA observed the following deficiencies: At 4:05pm, LPA observed during record review licensee did not maintain accurate records of cash resources. At 4:25pm, LPA observed medication in unlocked kitchen drawer in cups. At 4:25pm, LPA observed knives in unlocked kitchen drawer. At 4:27pm, LPA observed comet and Windex in unlocked kitchen cabinet underneath sink LPA requested the following documents to be submitted to CCLD by 12/20/2023. LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Surety bond Updated facility sketch Resident roster LIC 400 Affidavit Regarding Client/Resident Cash Resources The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights and this report provided.